| NPI | 1578584777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3098) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3451) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2013-07-17 |