| NPI | 1457473217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 3541) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1229) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2019-06-21 |