| NPI | 1790175388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1333) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 600) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2018-05-16 |