| NPI | 1881870459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 471) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1702) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-04-15 |