| NPI | 1184738064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 4498) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9940) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2008-04-15 |