| NPI | 1851696165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: SC 3613) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: SC 3613) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: SC 3613) | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2011-01-18 |