| NPI | 1043202724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 0008041) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2231) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2019-06-10 |