| NPI | 1477559649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 24437) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2108) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: TN 2108) | |
| 163W00000X Registered Nurse (Licence: TN 208311) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TN 24437) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2022-05-27 |