| NPI | 1275944506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5598) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2014013451) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2014-12-01 |