| NPI | 1922203785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R257074) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03527) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2025-07-24 |