| NPI | 1215940440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2008015775) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4833) |
| 111N00000X Chiropractor (Licence: OK 3847) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2015-04-06 |