| NPI | 1053418871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X008239) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH0034685) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-01-20 |