| NPI | 1770735284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7343308-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1352) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2016-06-27 |