| NPI | 1205059680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: AZ 5071) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: AZ 5071) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2016-10-07 |