| NPI | 1669440004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11028586) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9037) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2023-09-20 |