| NPI | 1942363148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 6706742-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1157) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2019-11-08 |