| NPI | 1497839195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 1644) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29072) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |