| NPI | 1730193731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5013429) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 1955) |
| 111NI0013X Chiropractor Independent Medical Examiner (Licence: NC 2677) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-08-14 |