| NPI | 1174761779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4212) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3425) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2014-08-05 |