| NPI | 1649391145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9307392) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH6247) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2018-08-17 |