| NPI | 1487811519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3366) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007073) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2008-08-27 |