| NPI | 1144681958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 103010) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01721) |
| 111NS0005X Chiropractor Sports Physician (Licence: AK 103010) | |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2024-02-13 |