| NPI | 1659767705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 083227) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03833) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2016-11-21 |