| NPI | 1609079706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 004157) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 942) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |