| NPI | 1295965705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01402) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6394) |
| 111N00000X Chiropractor (Licence: CA DC 31677) | |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2012-12-13 |