| NPI | 1649723438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1826) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 9183824-1202) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2024-02-12 |