| NPI | 1700068731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 1648) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 0104395) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2020-03-10 |