| NPI | 1093083271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2011013813) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 15924) |
| 171100000X Acupuncturist (Licence: AR 15924) | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2019-10-10 |