| NPI | 1851492292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2015034087) |
| Additional Taxonomies | 111NI0900X Chiropractor Internist (Licence: MO 005785) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-10-02 |