| NPI | 1497711360 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 04518) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 3519R) |
| 111N00000X Chiropractor (Licence: WI 1324012) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-08 |