| NPI | 1588606636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 20159) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC0000000723) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2017-01-19 |