| NPI | 1750662367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 52870) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 827) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2021-02-18 |