| NPI | 1235418807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 1179) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: MS 1179) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MS 1179) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: MS 1179) | |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2020-10-19 |