| NPI | 1487993044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 952) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5110) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2018-11-19 |