| NPI | 1285917393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5444) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2547) |
| Enumeration Date | 2011-09-25 |
| Last Update Date | 2023-01-16 |