| NPI | 1346260197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS R851434) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MS 1262) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2021-12-07 |