| NPI | 1649364753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 06504) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: IA 06504) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2009-10-09 |