| NPI | 1366585861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK CHIC418) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 0418) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2019-09-25 |