| NPI | 1457474199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3778) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010860) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2009-11-13 |