| NPI | 1508231788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2023049802) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 6238) |
| 225700000X Massage Therapist (Licence: OR 21766) | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2026-07-11 |