| NPI | 1639354822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11004162) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9462) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2019-10-05 |