| NPI | 1568680221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 721) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 928) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2011-11-28 |