| NPI | 1972521300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 003293) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 003105L) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |