| NPI | 1700886561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2005000287) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1379) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2008-04-29 |