| NPI | 1093069437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2014033058) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 8219055-1202) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2016-05-04 |