| NPI | 1942682174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD s03824) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MD U02569) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2019-01-04 |