| NPI | 1013392505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4198) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05737) |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2018-03-13 |