| NPI | 1265528491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 5881) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7551) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |