| NPI | 1346267044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3395) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10026) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |