| NPI | 1063660371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102206513) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 111N00000X Chiropractor (Licence: FL CH9564) | |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2021-07-21 |