| NPI | 1578820247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2025) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 5266084-1202) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2020-07-06 |