| NPI | 1104117001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 4057) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3326) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2013-09-25 |