| NPI | 1982729398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2165) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A05805) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2018-09-18 |