| NPI | 1033295688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03399) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 03399) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2010-11-16 |