| NPI | 1316050719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024185634) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70 011334) |
| 111N00000X Chiropractor (Licence: VA 0104557193) | |
| 163W00000X Registered Nurse (Licence: VA 0001286217) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11023357) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2023-01-20 |