| NPI | 1881094233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 8050) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1723) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2024-02-26 |