| NPI | 1104903194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-149036) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 1587) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-09-24 |