| 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 |