| NPI | 1073089413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2018031274) |
| Additional Taxonomies | 111NR0400X (Licence: MO 2018031274) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MO 2018031274) | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2018-10-23 |