| NPI | 1699115501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2440) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1659) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2024-04-02 |