| NPI | 1508814328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01082) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1083) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-08-26 |