| NPI | 1013086412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1067) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 4345) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2013-02-19 |