| NPI | 1033254404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 3997) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WY 582) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2019-09-17 |