NPI | 1720160328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 9233167) |
Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: FL 3457) |
Enumeration Date | 2006-10-20 |
Last Update Date | 2008-03-07 |