| NPI | 1760496699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD SO1514) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 1514) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2024-02-20 |