| NPI | 1922259605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3881) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3404) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2012-09-11 |