| NPI | 1063426476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA A05684) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A5684) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2011-06-06 |