| NPI | 1306910153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95005728) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC27259) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2021-03-05 |