| NPI | 1558412858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 1829) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 7357) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |