| NPI | 1164479366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 06641) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 4839) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2016-05-10 |