| NPI | 1639275134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1256) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5751) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2015-01-14 |