| NPI | 1164824132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: GA RN169582) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA GA008073) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2021-11-23 |