| NPI | 1093096034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6710) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4174) |
| Enumeration Date | 2011-09-05 |
| Last Update Date | 2011-09-05 |