| NPI | 1245694041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1675) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: ID CHIA-1675) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2021-02-07 |