| NPI | 1689811937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1164) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1549) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2010-06-04 |