| NPI | 1588916423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5077) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-2136) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2022-06-27 |