| NPI | 1275571853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4509) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3953) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2014-10-20 |