| NPI | 1821022252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2007030726) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 23033) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2008-11-03 |