| NPI | 1518267822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 144212) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 0105360) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2025-10-06 |