| NPI | 1538190491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 846277) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B720) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-04-08 |