| NPI | 1699093708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 490) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 557) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2010-05-13 |