| NPI | 1306206214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1882) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2016004505) |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2016-03-04 |