| NPI | 1306168950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2021000161) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 0105313) |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2021-05-14 |