| NPI | 1366833444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 076947) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1836) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2021-07-06 |