| NPI | 1811061021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5009874) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4045) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2022-05-16 |