| NPI | 1144201955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3843) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA1138) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2011-10-19 |