| NPI | 1811107550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 1712) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3730) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-08-19 |