| NPI | 1295012938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5013) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1194) |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2014-11-07 |