| NPI | 1932217999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 021802) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: GA 021802) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2016-02-24 |