| NPI | 1306332556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 092860) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-6936) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2024-04-18 |