| NPI | 1699906347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6386) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01277) |
| 111N00000X Chiropractor (Licence: AZ 7811) | |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2016-05-31 |