| NPI | 1891732095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 2428) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X008013) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2012-07-17 |