| NPI | 1407988785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 251086) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3728) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2022-09-28 |