| NPI | 1669702734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4598) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6470) |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2023-12-04 |