| NPI | 1093913006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2021039159) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL ch9395) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2021-12-28 |