| NPI | 1952466708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: SC 4018) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NC 4314) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2016-08-26 |