| NPI | 1942568373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16017) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6858) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2013-02-22 |