| NPI | 1477071686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 10768566-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2017031983) |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2021-02-05 |