| NPI | 1073765137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2294) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2020-10-08 |