| NPI | 1790779171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 4056) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 757CHI-inactive) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2008-07-15 |