| NPI | 1265533061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3453) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 8599) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2017-05-05 |