| NPI | 1316190101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2000151987) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: MO 2000151987) |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2008-10-24 |