| NPI | 1013080860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 06825) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5554) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2011-02-10 |