| NPI | 1689922734 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 1189) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: MS 721) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2012-08-21 |