| NPI | 1568960276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557499) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2018001424) |
| Enumeration Date | 2018-01-28 |
| Last Update Date | 2019-10-23 |