| NPI | 1114364569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 1762) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CO 6819) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2017-04-19 |