| NPI | 1053531335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 1391) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 1381) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2020-06-18 |