| NPI | 1619074218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 710) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 938) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2020-01-03 |