| NPI | 1760539241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S1459PT) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S01459) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2020-04-01 |