| NPI | 1144424946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MO 2006002027) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: KS 5025) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2011-08-31 |