| NPI | 1891935128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2009004813) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 0105229) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2012-07-31 |