| NPI | 1700062882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 886) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5561) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2012-03-09 |