| NPI | 1043651037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2013013534) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08003521A) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2025-07-08 |