| NPI | 1073884078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2012000070) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05557) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2013-07-10 |