| NPI | 1780175372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1835) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: LA 1835) |
| Enumeration Date | 2018-05-20 |
| Last Update Date | 2019-04-16 |