| NPI | 1285330142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2023001292) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-06235) |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2025-10-06 |