| NPI | 1932275203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 311) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: ND 1610) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-10-04 |