| NPI | 1053634832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03614) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MD U02139) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2021-03-23 |