| NPI | 1083670897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008980) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 009502) |
| 111N00000X Chiropractor (Licence: AZ 7990) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2012-08-30 |