| NPI | 1023588019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CH1A2081) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5952) |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2021-07-06 |