| NPI | 1013426998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5528) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 1023) |
| Enumeration Date | 2017-09-24 |
| Last Update Date | 2023-06-15 |