| NPI | 1386780906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 328280-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555765) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2010-01-06 |