| NPI | 1275864746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA1400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 7978681-1202) |
| Enumeration Date | 2010-01-23 |
| Last Update Date | 2011-09-30 |