| NPI | 1265590608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: CO 2281) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: OR 5909) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2018-07-19 |