| NPI | 1235462912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: MO 2009021008) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2009021008) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: MO 2009021008) | |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2010-05-11 |