| NPI | 1891706826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 977) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 305) |
| 111N00000X Chiropractor (Licence: CA 14482) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |