| NPI | 1285839704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95014152) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 815252) |
| 111N00000X Chiropractor (Licence: CA 29115) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2023-03-25 |