| NPI | 1053486480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 614) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 1220) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2009-06-18 |