| NPI | 1992754725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 005878) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 5878) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2016-12-28 |