| NPI | 1669482139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301500471) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002056) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2019-07-23 |