| NPI | 1043540388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 4945832-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8102) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2011-06-14 |