| NPI | 1578572046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11046222) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x009550) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2026-04-28 |