| NPI | 1871731984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3419) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3920) |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2011-02-21 |