| NPI | 1396189940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4743) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4273) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2021-12-28 |