| NPI | 1427147735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-01801) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1453) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2011-06-29 |