| NPI | 1528050622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 02461) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 04861) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2025-12-11 |