| NPI | 1518017078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 201802941) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-2184) |
| 111N00000X Chiropractor (Licence: OK 4402) | |
| 111N00000X Chiropractor (Licence: OR 272267) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-08-09 |