| NPI | 1063545663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 9136593-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002412A) |
| 111N00000X Chiropractor (Licence: AL 2210) | |
| 111N00000X Chiropractor (Licence: GA CHIRO08163) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2022-08-22 |