| NPI | 1699838037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 1440) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: OH 3009) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2023-09-07 |