| NPI | 1497705396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC F2945) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 0905) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC F2945) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2015-01-10 |