| NPI | 1396250718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2017039451) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05978) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: KS 01-05978) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: MO 2017039451) | |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2020-11-23 |