| NPI | 1124194519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7087) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 20144016190) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2016-02-18 |