| NPI | 1689063265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2016010041) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05675) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2016-04-04 |