| NPI | 1831321157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP024995) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010135) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2023-10-20 |