| NPI | 1669475042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 4087) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 2915891202) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2007-07-08 |