| NPI | 1942299854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R232006) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-087292) |
| 111N00000X Chiropractor (Licence: AL 2126) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2025-08-26 |