| NPI | 1972597623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6094) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007155) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2009-01-05 |