| NPI | 1558548677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5731) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2296) |
| 111N00000X Chiropractor (Licence: WI 4367-12) | |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2020-07-13 |