| NPI | 1164833919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 970) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: ND 970) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2015-02-25 |