| NPI | 1699737502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP012206) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC007232L) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2025-10-21 |