| NPI | 1811981707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 005086) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 1550) |
| 111N00000X Chiropractor (Licence: FL 5684) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2008-04-15 |