| NPI | 1760429732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: OR 27-3110) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CO 4394) |
| 111NX0800X Chiropractor, Orthopedic (Licence: UT 7912009-1202) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2017-01-25 |