| NPI | 1497404644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2022010602) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 6366-12) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-03-05 |