| NPI | 1861402141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 876) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 370033-1202) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2007-07-08 |