| NPI | 1649229659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1515) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06874) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2011-09-29 |