| NPI | 1639150980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: AZ 5122) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: NM 1205) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2007-07-08 |