| NPI | 1649277716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9326868) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH0008332) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2013-08-02 |