| NPI | 1942594437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: GA MT0011476) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN712951) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2026-03-30 |