| NPI | 1275661142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: AK 129) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: HI 407) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-07-09 |