| NPI | 1013903988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3436) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 1776) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2021-10-20 |