| NPI | 1467792044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 8547239-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2013002496) |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2013-03-14 |