| NPI | 1750472239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4005) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B727) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2010-07-15 |