| NPI | 1225568025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2701) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 120472) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2023-09-19 |