| NPI | 1134340284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC30583) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5724) |
| 111N00000X Chiropractor (Licence: CT 001621) | |
| 111N00000X Chiropractor (Licence: KS 0104945) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2007-07-08 |