| NPI | 1578767364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B-527) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NV B-527) |
| 111NX0800X Chiropractor, Orthopedic (Licence: NV B-527) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2007-07-08 |