| NPI | 1811945363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1039) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NC 272) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2011-04-27 |