| NPI | 1275715435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 587) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: SD 587) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2009-09-22 |