| NPI | 1508406554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2019046195) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MO 2019046195) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2021-08-28 |