| NPI | 1184658700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 556) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 797) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2012-03-15 |