| NPI | 1801331335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 132598) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC4535) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2023-11-06 |