| NPI | 1528305810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-1242) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010925) |
| 111N00000X Chiropractor (Licence: WA CH60339060) | |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2019-06-06 |