| NPI | 1588023592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2016000070) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011116) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2017-01-31 |