| NPI | 1720490865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1352) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2014015304) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2022-07-21 |