| NPI | 1386751956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP009548) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 003222-L) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2024-06-17 |