| NPI | 1295843696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1930) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 6001) |
| 111N00000X Chiropractor (Licence: CO 4218) | |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2010-06-30 |