| NPI | 1114961703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 6561) |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| 111NN0400X Chiropractor, Neurology (Licence: CT 001133) | |
| 163W00000X Registered Nurse (Licence: CT 118083) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2016-07-12 |