| NPI | 1386875284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3977) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1539) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2020-04-29 |