| NPI | 1912900770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S01788) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 01788) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2012-03-01 |