| NPI | 1376639633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT MT472) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 472) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-05-23 |