| NPI | 1336153568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 542) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5785) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-02-07 |