| NPI | 1033838412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2024031395) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 15041) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2024-08-20 |