| NPI | 1194831115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 006814) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MO 006814) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-04-30 |