| NPI | 1871858381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2012016839) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05485) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-10 |