| NPI | 1265774970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4513) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3840) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2020-11-18 |