| NPI | 1912183351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 507) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: WY 507) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2008-02-19 |