| NPI | 1871542571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 17854) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2603) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2021-07-06 |