| NPI | 1396868204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 483) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2005009949) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2008-07-25 |