| NPI | 1467760397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 577) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 111N00000X Chiropractor (Licence: TX 11600) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2013-12-20 |