| NPI | 1275660391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 0795) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 795) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2011-02-25 |