| NPI | 1437648623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: MO 2018001705) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2018001705) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2022-10-05 |