| NPI | 1194705822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 934) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A06036) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2017-04-25 |