| NPI | 1043310980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR2252) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-04546) |
| 111NR0400X (Licence: TX 10690) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2018-10-30 |