| NPI | 1366528069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S01270) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: MD S01270) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2013-09-05 |