| NPI | 1548342603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3247) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555901) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2014-08-05 |