| NPI | 1144643875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1779) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: NE 3435763523) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2014-01-31 |