| NPI | 1306802970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S02178) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5777) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2020-06-14 |