| NPI | 1164745543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009247) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA dc31541) |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2014-05-20 |