| NPI | 1598986457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2007034170) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10212) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2025-05-28 |