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 |