| NPI | 1093063497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1731) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007586) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2013-01-09 |