| NPI | 1366638603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: NE 1742) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5075) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2016-11-01 |