| NPI | 1821014861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 03495) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC23362) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2012-11-29 |