| NPI | 1528147725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1177) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WY 662) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-12-31 |