| NPI | 1194735605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01178) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 12565) |
| 111N00000X Chiropractor (Licence: FL CH4388) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2013-04-29 |