| NPI | 1609883941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2983) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: SC 4248) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-06-16 |