| NPI | 1083833420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC11306) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 730) |
| 111N00000X Chiropractor (Licence: CO CHR3740) | |
| 111N00000X Chiropractor (Licence: AZ 3117) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2008-05-03 |