| NPI | 1831380484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 1194) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10172) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2011-11-15 |