| NPI | 1700161775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 2019) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8225) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2019-10-14 |