| NPI | 1316135163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NM CNP-01993) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1709) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2018-05-17 |