| NPI | 1144295833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AR 216876) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 1544) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-12-13 |