| NPI | 1053361949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 03450) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE 0000531) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2015-11-18 |