| NPI | 1013013143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 1847) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: AL 1847) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2019-05-11 |