| NPI | 1588864342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1484) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1155) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2017-05-10 |