| NPI | 1902864457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 6970420-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5486) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2009-02-20 |