| NPI | 1821320409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03654) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 03654) |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2012-03-01 |