| NPI | 1689621971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4014) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other |
| 111N00000X Chiropractor (Licence: NC 4427) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2016-05-12 |