| NPI | 1194805721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 15694) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3196) |
| 111N00000X Chiropractor (Licence: NC 3136) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2009-05-14 |