| NPI | 1881765568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-5039) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ DC5017) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2017-10-24 |