| NPI | 1316951338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 6433) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 4863) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-10-01 |