| NPI | 1871084038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 674) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03974) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2021-05-21 |