| NPI | 1881099760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3991) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: SC 3991) |
| 111NR0400X (Licence: SC 3991) | |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2022-07-21 |