| NPI | 1215245824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2016030152) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5251) |
| 163W00000X Registered Nurse (Licence: NM RN-80240) | |
| 363LF0000X Nurse Practitioner Family (Licence: NM CNP-02496) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2017-10-06 |