| NPI | 1912321308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3443) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5520) |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2024-01-19 |