| NPI | 1649341264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2220) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2004011261) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2013-02-13 |