| NPI | 1811062441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 072217) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00034266) |
| 111N00000X Chiropractor (Licence: IL 038.011478) | |
| 111N00000X Chiropractor (Licence: OR 3670) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2014-08-05 |