| NPI | 1487809430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD AC003467) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2259) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-148731) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2021-01-27 |