| NPI | 1164603171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4380) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556560) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2013-11-21 |