| NPI | 1871554410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A004000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 1554) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2019-03-05 |