| NPI | 1669437034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 104873) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4619) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2016-05-10 |