| NPI | 1386682862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1325A) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: ID CHIA-901) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2021-09-03 |