| NPI | 1083647820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 22764) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC28407) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-03-22 |