| NPI | 1861575961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA434) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ID ACC79) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-09-28 |