| NPI | 1245361450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 698) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ND 698) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2022-01-04 |