| NPI | 1730456419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1811) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007468) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2017-03-21 |