| NPI | 1174046288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 087967) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: IA 347) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2024-05-20 |