| NPI | 1629458955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6267) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 5096 - 12) |
| 111N00000X Chiropractor (Licence: AZ 8740) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2023-04-05 |