| NPI | 1083896179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6122) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60187362) |
| 111N00000X Chiropractor (Licence: TN 2514) | |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2024-12-02 |