| NPI | 1659371912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 1208) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: SC 1208) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2010-08-24 |