| NPI | 1336442466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11012178) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: FL CH10148) |
| Enumeration Date | 2010-12-11 |
| Last Update Date | 2024-02-09 |