| NPI | 1104462977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5249) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3243) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2021-11-01 |