| NPI | 1578019576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4942) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557370) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2024-02-26 |