| NPI | 1124324108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4850) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2795) |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2017-12-07 |