| NPI | 1962593491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 887) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WY 421) |
| 111N00000X Chiropractor (Licence: MT 513) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |