| NPI | 1811916026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3000) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2010-02-24 |