| NPI | 1336309731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 1207) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MS 1142) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2014-09-22 |