| NPI | 1407890148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 004435) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: MO 004435) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2021-08-26 |