| NPI | 1669716007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3786) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: SC 3786) |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2012-11-26 |