| NPI | 1851539845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1351) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA1531) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2013-01-23 |