| NPI | 1801075106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3408) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3792) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2019-06-11 |