| NPI | 1528268612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1451) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6084) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2023-03-09 |