| NPI | 1053786210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9227781) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7990) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |