| NPI | 1336197946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4793) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 305CH1) |
| 111N00000X Chiropractor (Licence: ID CH11499) | |
| 111N00000X Chiropractor (Licence: OR 282560) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-07-08 |