| NPI | 1043301682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: ID NP-1452A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1210) |
| 363LF0000X Nurse Practitioner Family (Licence: NV 822860) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-06-10 |