| NPI | 1255485504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 02132) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: MD 02132) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2010-01-14 |