| NPI | 1821124066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1181) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2911) |
| 111N00000X Chiropractor (Licence: AZ 8334) | |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2016-01-13 |