| NPI | 1912565755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: NC 4998) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: NC 4998) |
| 111NX0800X Chiropractor, Orthopedic (Licence: NC 4998) | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-06-05 |