| NPI | 1003468372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4455) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 0008050) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2019-07-16 |