| NPI | 1891762084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7691) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-03416) |
| 111N00000X Chiropractor (Licence: NE 644) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2007-07-09 |