| NPI | 1922207737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1394) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MS 1109) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2007-07-12 |