| NPI | 1548370646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 0102076) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 3382) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-11-03 |