| NPI | 1588195085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 37029) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010557) |
| 111NN0400X Chiropractor, Neurology (Licence: TN 0000003219) | |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2024-09-03 |