| NPI | 1619288875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC #4096) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC #3437) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2010-06-23 |