| NPI | 1417161969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 1289) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 452) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2008-02-06 |