| NPI | 1205838711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3475) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5826) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2021-06-15 |