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 |