| NPI | 1609962208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA 1282) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06485) |
| 111N00000X Chiropractor (Licence: MT 1171) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-01-08 |