| NPI | 1487607677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1442) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3439) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-06-03 |