| NPI | 1083040018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10986) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME141598) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9324063) | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2019-04-10 |