| NPI | 1336765015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 123217) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2020012516) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2024-04-02 |