| NPI | 1407865561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1126) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1202) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2022-01-03 |