| NPI | 1386144301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01774) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MS 1282) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2019-07-09 |