| NPI | 1548336050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4028) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 548) |
| 111N00000X Chiropractor (Licence: MA 1530) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2010-03-19 |