| NPI | 1134541923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4777) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 927) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2018-03-17 |