| NPI | 1295812154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2567) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2980) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2007-07-08 |