| NPI | 1538457585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5070) |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| 111N00000X Chiropractor (Licence: FL CH10350) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2014-09-26 |