| NPI | 1619166063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 6760623-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA1581) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2014-02-11 |