| NPI | 1851394050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA A05924) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: IA A05924) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2020-05-18 |