| NPI | 1568844975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202D00000X (Licence: ID 59038) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1864) |
| 363LF0000X Nurse Practitioner Family (Licence: ID 59038) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2022-06-28 |