| NPI | 1104390343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: AZ 9030) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2018045551) |
| 111N00000X Chiropractor (Licence: NE 1994) | |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2021-07-28 |