| NPI | 1255382990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024173222) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556467) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2016-05-12 |