| NPI | 1376500363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 0770) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: SC 116) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2020-11-25 |