| NPI | 1215903315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID Chia-1110) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3575) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2007-10-22 |