| NPI | 1861405425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO 0991260) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 3190) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2014-12-04 |