| NPI | 1508802695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 748) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-04793) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2015-03-11 |