| NPI | 1760805824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 075795) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4446) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2016-01-06 |