| NPI | 1811063456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 080802) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7399) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2016-12-08 |