| NPI | 1740341494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11007814) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 9313) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-06-29 |