| NPI | 1003519455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2023015283) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008623) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2024-05-29 |