| NPI | 1992876411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 751) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 3196) |
| 111N00000X Chiropractor (Licence: AK 470) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2016-03-22 |