| NPI | 1669439022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 06537) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8517) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2016-05-23 |