| NPI | 1174989750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4633) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104-557301) |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2018-03-17 |