| NPI | 1639613961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 148991) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557374) |
| 111N00000X Chiropractor (Licence: FL CH12196) | |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2020-04-02 |