| NPI | 1124545181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104558191) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2017031028) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2026-07-30 |