| NPI | 1760864672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01931) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1684) |
| 111N00000X Chiropractor (Licence: AK 112686) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2022-04-20 |