| NPI | 1174517858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA 470) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ID ACC-57) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2010-06-28 |