| NPI | 1154305837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019008101) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH0008078) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2026-06-05 |