| NPI | 1033177076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 06882) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008112) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2017-01-17 |