| NPI | 1083778914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5004089) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 879) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2014-03-17 |