| NPI | 1053529966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 04956) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 5800100) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |