| NPI | 1437491636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2013001703) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: MO 2013001703) |
| 111NX0800X Chiropractor Orthopedic (Licence: MO 2013001703) | |
| 111NN1001X Chiropractor Nutrition (Licence: MO 2013001703) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2013-05-06 |