| NPI | 1124742812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2023049804) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 5542) |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2024-05-13 |