| NPI | 1770643108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO CE004325) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7135) |
| 111N00000X Chiropractor (Licence: CO 2988) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |