| NPI | 1134662133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: MN 6888) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO A53680489349) |
| 111N00000X Chiropractor (Licence: MO 2017007832) | |
| 111N00000X Chiropractor (Licence: WV 1023) | |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2022-06-14 |