| NPI | 1962534222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 01708) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 006265) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2011-12-05 |