| NPI | 1063843738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2814) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 1048) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2013-12-06 |