| NPI | 1144411067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 1059) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 2724) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2007-08-06 |