| NPI | 1215051255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-2922) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1143) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2023-09-11 |