| NPI | 1942396403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 1999134950) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-04637) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2010-07-28 |