| NPI | 1639356900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT CHI-1081) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1081) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2009-06-10 |