| NPI | 1881682961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: IA 4884) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: IA 4884) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2011-01-25 |