| NPI | 1669642013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 1046) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WY 631) |
| Enumeration Date | 2008-03-01 |
| Last Update Date | 2013-06-03 |