| NPI | 1528690732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-81608-101) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2016016282) |
| 363L00000X Nurse Practitioner (Licence: MO 2020032639) | |
| 363L00000X Nurse Practitioner (Licence: OR 10013535) | |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2024-01-04 |