| NPI | 1801928700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 0987) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS F0113056) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2022-03-11 |