| NPI | 1366494007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 71 3653) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7493) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-08 |