| NPI | 1306885868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 774297) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9057) |
| 1835N1003X Pharmacist Nutrition Support (Licence: TX 40577) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-10-08 |