| NPI | 1942344254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 2090) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2007035560) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2014-12-11 |