| NPI | 1801133186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1745) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1228) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2023-08-14 |