| NPI | 1083798169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC2153) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 22328) |
| 163W00000X Registered Nurse (Licence: TN 193152) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3011150) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2019-02-14 |