| NPI | 1609093384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: LA 1436) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: LA 1436) |
| 111NN1001X Chiropractor Nutrition (Licence: LA 1436) | |
| 111NR0200X Chiropractor Radiology (Licence: LA 1436) | |
| 111NX0800X Chiropractor Orthopedic (Licence: LA 1436) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2008-10-31 |