| NPI | 1851556229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-13372) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: ID M-13372) | |
| 111N00000X Chiropractor (Licence: CO 6254) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2024-05-06 |