| NPI | 1104012467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007545) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6125) |
| 111N00000X Chiropractor (Licence: NE 1685) | |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2024-02-06 |