| NPI | 1225096829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1058) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 1264) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2013-03-22 |