| NPI | 1922440809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1638) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2013025398) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2015-03-12 |