| NPI | 1013933787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9322426) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH0005153) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2014-03-12 |