| NPI | 1922271527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2396) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 725) |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2020-01-03 |