| NPI | 1336245067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11022437) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B00852) |
| 363L00000X Nurse Practitioner (Licence: NV APRN002152) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2022-10-21 |