| NPI | 1891199097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: NV B01539) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NV B01539) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NV B01539) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: NV B01539) | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2014-10-17 |