| NPI | 1205612736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2018026263) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: MO 2018026263) |
| 111NP0017X Chiropractor Pediatric Chiropractor (Licence: MO 2018026263) | |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2023-08-31 |