| NPI | 1164576351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3859) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2007000669) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2008-10-13 |