| NPI | 1124011630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2010040956) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4606) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2011-09-22 |