| NPI | 1154407468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NP95019081) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 20680) |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2021-12-08 |