| NPI | 1154358414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6541) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC008714) |
| 111N00000X Chiropractor (Licence: AK 467) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2010-11-19 |