| NPI | 1437265477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 2198) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4234) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2017-04-28 |