| NPI | 1306070313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 006762) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05303) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2015-07-29 |