| NPI | 1083619514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1786) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 1384) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2017-03-30 |