| NPI | 1730103888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6176) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009253-2) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2011-06-15 |