| NPI | 1720169121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3232) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 801) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2008-02-07 |