| NPI | 1114195310 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 1181) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MT 1181) |
| 111NR0200X Chiropractor, Radiology (Licence: MT 1181) | |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2008-02-14 |