| NPI | 1518949478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 634) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MT 634) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2020-06-24 |