| NPI | 1104846005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN212358) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 006975) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2016-02-08 |