| NPI | 1952656506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WM1400X Registered Nurse, Nurse Massage Therapist (NMT) (Licence: AK 28163) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 28163) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2012-10-23 |