| NPI | 1477808756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4981) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3759) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2019-01-14 |