| NPI | 1285608620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 4631) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 1295) |
| 111N00000X Chiropractor (Licence: WI 3862-012) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2007-07-09 |