| NPI | 1659578342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001729) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4707) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2018-10-19 |