| NPI | 1952647612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16019) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2013000463) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2016-05-12 |