| NPI | 1780685255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1564) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 2047) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2013-11-26 |