| NPI | 1790840429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 650) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: NM 650) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2020-11-11 |