| NPI | 1043547961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2627) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6389) |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2020-09-03 |