| NPI | 1578535191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 022 A06204) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A06204) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2019-01-08 |