| NPI | 1184923690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007584) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1660) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2022-07-12 |