| NPI | 1740253335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-01946) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1600) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2020-09-09 |