| NPI | 1538244637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01176) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2118) |
| 111N00000X Chiropractor (Licence: CA DC-30027) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2007-07-08 |