| NPI | 1871690222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1781) |
| Additional Taxonomies | 111NP0017X Chiropractor Pediatric Chiropractor (Licence: NC 1781) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-05-06 |