| NPI | 1699817130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: NH 960) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: OH 1364) |
| 111NR0200X Chiropractor, Radiology (Licence: GA CHIR009086) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-01-06 |