| NPI | 1386863504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 0001717) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4120) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2008-05-06 |