| NPI | 1164776183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3777) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4966) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2019-09-18 |