| NPI | 1972912467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 309560) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: TX 6480) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2018-09-06 |