| NPI | 1194711663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 2628) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2310) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2019-11-27 |