| NPI | 1942491352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009239) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29501) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2014-07-14 |