| NPI | 1356372767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 162-340-009) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2004008742) |
| 111N00000X Chiropractor (Licence: NY X010879) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2010-02-04 |