| NPI | 1053660084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 125793) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 0000002599) |
| 111N00000X Chiropractor (Licence: KS 01-05561) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2022-04-07 |