| NPI | 1235259219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: SC 4131) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CT 517) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2016-12-09 |