| NPI | 1770847469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 5271243) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 32327) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2025-03-13 |