| NPI | 1639555097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR2465) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009565) |
| 111NN1001X Chiropractor, Nutrition (Licence: GA CHIR009565) | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2018-07-10 |