| NPI | 1205896412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2002030435) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 4943) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2016-11-29 |