| NPI | 1134153257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 4237) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 3590) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-10-01 |