| NPI | 1952470197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 362) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MT 1388) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2012-03-29 |