| NPI | 1538197116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: SC 2283) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2283) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2018-09-10 |