| NPI | 1467807982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2002) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05773) |
| 111N00000X Chiropractor (Licence: MO 2016004526) | |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2024-08-15 |