| NPI | 1851562243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3515) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 006500) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2011-07-26 |