| NPI | 1568609840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3509) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 6573) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2019-10-30 |