| NPI | 1316429368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 5577) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1348) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2023-08-24 |