| NPI | 1730185794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 658) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 834) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2019-04-29 |