| NPI | 1750383444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2162) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2465) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2008-11-12 |