| NPI | 1356600647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1772) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5054) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2023-06-12 |