| NPI | 1326181397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ RNP253356) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7398) |
| 246ZE0600X Specialist/Technologist, Other Electroneurodiagnostic | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2023-06-07 |