| NPI | 1730186800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9317352) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH0005687) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2024-05-17 |