| NPI | 1275734808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: IA 038-007550) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: IL 038-007550) |
| 111NX0800X Chiropractor, Orthopedic (Licence: IL 038-007550) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2007-07-08 |