| NPI | 1114966827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6209) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2807) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2009-10-21 |