| NPI | 1760492482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3802) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3037) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2017-04-07 |