| NPI | 1982691911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: SD 868) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: SD SD868) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2010-10-05 |