| NPI | 1952336240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 5886) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1174) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2024-09-24 |