| NPI | 1437239696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2006025892) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 7814003-1202) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2010-12-22 |