| NPI | 1093363939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 688) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: PR 688) |
| 111NN1001X Chiropractor, Nutrition (Licence: PR 688) | |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2019-09-03 |