| NPI | 1801839139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor Orthopedic (Licence: FL 0002363) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 92135) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL 92135) | |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: FL 92135) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-02-15 |