| NPI | 1134439755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7779072-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1429) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2012-03-20 |