| NPI | 1124403357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 109516) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 9452589-1202) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2016-05-31 |