| NPI | 1407166010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV B01252) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01252) |
| 111NN1001X Chiropractor, Nutrition (Licence: NV B01252) | |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2013-09-16 |