| NPI | 1013348143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 076219) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 0007061) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2022-07-21 |