| NPI | 1346398088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2008015698) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002218A) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2023-05-09 |