| NPI | 1306038799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2010033591) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-04331) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2017-08-07 |