| NPI | 1265704688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: MO 2012008307) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2012008307) |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2025-09-04 |