| NPI | 1679758668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP026213) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC006634) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2022-11-09 |