| NPI | 1083697338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3122) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2539) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2011-03-22 |