| NPI | 1598067340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 1171) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: MS 1711) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2016-03-03 |