| NPI | 1659406759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 20414) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3339) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2017-12-06 |