| NPI | 1790042653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 8167753-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5039) |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2014-11-07 |