| NPI | 1356628135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR 007468) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B 01186) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2011-11-10 |