| NPI | 1780694539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL TRN18619) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-008646) |
| 111N00000X Chiropractor (Licence: FL Ch7548) | |
| 207P00000X Emergency Medicine (Licence: FL ME124773) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2017-01-25 |