| NPI | 1225658164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1170) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 6175) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2022-08-15 |