| NPI | 1346240645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11012467) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 4512) |
| 111N00000X Chiropractor (Licence: TX 6788) | |
| 163WW0000X Registered Nurse, Wound Care (Licence: FL 9504823) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 207940) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP002160) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2024-05-02 |