| NPI | 1407260425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2015005071) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 16374) |
| 111NI0013X Chiropractor, Independent Medical Examiner (Licence: AR 16374) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2024-02-26 |