| NPI | 1962475368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1387) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2461) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-08-29 |