| NPI | 1558462887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3616) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 1610) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-02-26 |