| NPI | 1124219084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA276) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ID ACC106) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2015-09-16 |