| NPI | 1568724136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 8709683-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1503) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2013-08-08 |