| NPI | 1245603240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4711) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 0007313) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2024-03-28 |