| NPI | 1508263203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 9167751-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-2115) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2023-09-29 |