| NPI | 1598899569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: MD S01758) |
| Additional Taxonomies | 111NR0400X (Licence: MD S01758) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |