| NPI | 1215921556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3599) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3158) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2012-09-18 |