| NPI | 1891760534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NM MD3816812) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: TX 8241) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2017-11-29 |