| NPI | 1518146307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4330) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2209) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2020-12-21 |