| NPI | 1477826048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2014000302) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3681) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2014-02-18 |