| NPI | 1891838801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 584) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5347) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2014-03-18 |