| NPI | 1588980411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: IA 007321) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007321) |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2021-11-18 |