| NPI | 1659539369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 6982285-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7840) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2008-05-29 |