| NPI | 1720006950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: MO 5706) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: KS 01-03843) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-10-12 |