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 |