| NPI | 1275650129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2004014221) |
| Additional Taxonomies | 111NR0200X Chiropractor Radiology (Licence: MO 2004014221) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2007-07-08 |