| NPI | 1124148796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 3807) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 22342) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |