| NPI | 1417060997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA A05429) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: IA A05429) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2024-04-30 |