| NPI | 1922424035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16063) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: MO 2014003605) |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2021-03-23 |