| NPI | 1659467751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: SC 779SC) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: SC 779) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-06-15 |