| NPI | 1578738423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 15696) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5107) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2015-07-15 |