| NPI | 1942212451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2004008980) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MO 2004008980) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2007-11-20 |