| NPI | 1720218183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1343) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002545A) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2013-03-26 |