| NPI | 1770688814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95013805) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 14349) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-02-09 |