| NPI | 1376019992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2018032970) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2584) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2023-01-06 |