| NPI | 1285966598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1501) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3994) |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2012-04-25 |