| NPI | 1700929767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 2873) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B-899) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2015-06-03 |