| NPI | 1508438334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2021022187) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008397) |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2023-08-28 |