| NPI | 1518167899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-18664) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2193) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2024-12-11 |