| NPI | 1134277254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 7066932-8900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MS 1008) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-07-17 |