| NPI | 1457461840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 5290) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 724) |
| 111N00000X Chiropractor (Licence: AZ 4261) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |