| NPI | 1306262704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4453) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4048) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2016-04-08 |