| NPI | 1285037689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2013013772) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MO 2013013772) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2019-07-15 |