| NPI | 1568537041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 882) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 05011) |
| 111N00000X Chiropractor (Licence: MO 005011) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-18 |