| NPI | 1578611273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 285738-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3110) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2012-08-01 |