| NPI | 1912329897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MO 2014000855) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: MO 2014000855) |
| 111NX0800X Chiropractor, Orthopedic (Licence: MO 2014000855) | |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2014-01-13 |