| NPI | 1851324735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4616) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B-808) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-07-01 |