| NPI | 1972801397 |
|---|---|
| Former Name | JONATHAN BRAD EGBERT |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD193108) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA1449) |
| 207Q00000X Family Medicine (Licence: WY 098-T2) | |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2022-04-25 |