| NPI | 1932293453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2480) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 6699) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2013-07-08 |