| NPI | 1366445256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA A05784) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2124) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2010-08-27 |