| NPI | 1023309077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4384) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: NC 4384) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2018-07-27 |