| NPI | 1629337829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 8303581-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2012004603) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2012-08-14 |