| NPI | 1184992976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 798) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2010040257) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2024-01-24 |