| NPI | 1336480888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03901) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4338) |
| Enumeration Date | 2013-03-08 |
| Last Update Date | 2021-12-15 |