| NPI | 1215384276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor Independent Medical Examiner (Licence: SC 4149) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4149) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2022-09-16 |