| NPI | 1679633275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3891) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3007) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2014-04-24 |