| NPI | 1164727921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 0006833) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4158) |
| 111N00000X Chiropractor (Licence: IA 007370) | |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2013-12-20 |