| NPI | 1942201124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 174690-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 2520) |
| 111N00000X Chiropractor (Licence: ID CHIA-389) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2010-11-10 |