| NPI | 1437416690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 285) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: LA 285) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2012-04-12 |