| NPI | 1447494836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3947) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2009000025) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-04-29 |