| NPI | 1982761672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01779) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 3136171202) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-02-06 |