| NPI | 1841742764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1347) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 084587) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2019-10-08 |