| NPI | 1558344754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4384) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2003013226) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2024-10-29 |