| NPI | 1346227030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1669) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 19323) |
| 111N00000X Chiropractor (Licence: TX 4713) | |
| 111N00000X Chiropractor (Licence: MI 6666) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2007-07-08 |