| NPI | 1841280757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 04906) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 282) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2008-08-21 |