| NPI | 1073705463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3753) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3060) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2007-08-09 |