| NPI | 1225588502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 8188) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 7.002050) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2020-04-15 |