| NPI | 1396233383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6047) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01691) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2020-03-24 |