| NPI | 1568541951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95020240) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 27503) |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2022-03-23 |