| NPI | 1548627813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16134) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2016000847) |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2016-07-21 |