| NPI | 1194950105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3622) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3942) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2021-04-28 |