| NPI | 1669425070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2000172546) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-04975) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2018-12-18 |