| NPI | 1942299854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-087292) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2126) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2022-04-25 |