| NPI | 1992059216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3821) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4328) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2013-04-23 |