| NPI | 1194480053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5392) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104-557769) |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2021-11-05 |