| NPI | 1245265305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 003718) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MO 003718) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2008-11-10 |