| NPI | 1326199688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 1085) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: MT 1085) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MT 1085) | |
| 111NT0100X Chiropractor, Thermography (Licence: MT 1085) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |