| NPI | 1689769689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6463) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011098) |
| 111N00000X Chiropractor (Licence: GA CHIRO006402) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2010-02-11 |