| NPI | 1871606624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024821) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8457) |
| 111N00000X Chiropractor (Licence: IL 038007974) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2023-03-13 |