| NPI | 1760566699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1225) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 4842701-1202) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-09-19 |