| NPI | 1740406594 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO DRC005253) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: MO DRC005253) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MO DRC005253) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |