| NPI | 1184665812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 728-0704) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2945) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2016-06-27 |