| NPI | 1831161504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 262A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 1644) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2011-04-15 |