| NPI | 1538389085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4099) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3255) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2025-01-14 |