| NPI | 1508023367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2010024744) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6231) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2011-02-24 |