| NPI | 1750561114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1462) |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified (Licence: LA lt3700) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2011-02-17 |