| NPI | 1821436759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3962) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010834) |
| 111N00000X Chiropractor (Licence: MO 2014035753) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2018-12-17 |