| NPI | 1194279075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4065) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: SC 4065) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2022-04-26 |