| NPI | 1811136310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11038867) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9696) |
| Enumeration Date | 2009-02-07 |
| Last Update Date | 2025-05-22 |