| NPI | 1649557968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN240492) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4230) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2019-03-22 |