| NPI | 1831192715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO CE-006306) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 4298) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2012-12-21 |