| NPI | 1417286360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 093290) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1738) |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2019-05-23 |