| NPI | 1699947911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4019) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3817) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2009-12-10 |