| NPI | 1245563683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3963) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3488) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2009-09-17 |