| NPI | 1740314442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID chia-2246) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 273407) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2023-06-02 |