| NPI | 1497851109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AL 1-137890) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2161) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2017-05-30 |