| NPI | 1477758126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 70076651202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2007011977) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2008-08-04 |