| NPI | 1841306644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 5705) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 719) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP135209) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2018-05-01 |