| NPI | 1104826866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 572) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: SD 572) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2007-11-06 |