| NPI | 1386785939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 9213627-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-851) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2014-12-16 |