| NPI | 1093996373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 6961493-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30661) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2014-01-08 |