| NPI | 1295728814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 910CHI) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA885) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2007-11-27 |