| NPI | 1134288541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 211821) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 10461) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2021-04-13 |