| NPI | 1861601528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5091) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5856) |
| 111N00000X Chiropractor (Licence: CA 29940) | |
| 111N00000X Chiropractor (Licence: IL 038011001) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2009-05-21 |