| NPI | 1871734137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1568) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8027) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2009-10-28 |