| NPI | 1083766539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1130) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 2233) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2012-01-27 |