| NPI | 1790837284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 04082) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 02204082) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2022-01-26 |