| NPI | 1275587164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 5899) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7668) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2008-03-04 |