| NPI | 1033705520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2025026277) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 4388) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2026-08-07 |