| NPI | 1013424357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2020035024) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5562) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2020-10-19 |