| NPI | 1154061315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5525) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2022010774) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-12-01 |