| NPI | 1760620421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2008035499) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05236) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2010-03-16 |