| NPI | 1447689849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2019013211) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557120) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2019-08-05 |