| NPI | 1518185313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 5600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 20810) |
| 111N00000X Chiropractor (Licence: CO 3308) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |