| NPI | 1386104727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2017023045) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 4442) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2026-06-16 |