| NPI | 1194066613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2412) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1630) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2023-09-19 |