| NPI | 1811054547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 1180) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4275) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2008-03-28 |