| NPI | 1073865499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 80285) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0006904) |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80285-061) | |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2021-08-04 |