| NPI | 1225123573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK CHIC365) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA933) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-01-16 |